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Journal of Korean Neurosurgical Society > Volume 27(5); 1998 > Article
Journal of Korean Neurosurgical Society 1998;27(5): 606-611.
Pediatric Moyamoya Disease: Perioperative Cerebral Blood Flow and MR Angiography Studies.
Hyung Jin Shin, Do Hyun Nam, Soo Hyun Hwang, Jung Il Lee, Jong Soo Kim, Seung Chyul Hong, Kwan Park, Whan Eoh, Mun Hyang Lee, Hye Kyung Yoon, Sang Eun Kim, Jong Hyun Kim
1Department of Neurosurgery, Sung Kyun Kwan University, College of Medicine, Samsung Medical Center, Seoul, Korea.
2Department of Pediatrics, Sung Kyun Kwan University, College of Medicine, Samsung Medical Center, Seoul, Korea.
3Department of Diagnostic Radiology, Sung Kyun Kwan University, College of Medicine, Samsung Medical Center, Seoul, Korea.
4Department of Nuclear Medicine, Sung Kyun Kwan University, College of Medicine, Samsung Medical Center, Seoul, Korea.
ABSTRACT
To assess the role of magnetic resonance angiography(MRA) and the effect of encephaloduroarteriosynangiosis (EDAS) on the pediatric moyamoya disease(MMD), we analyzed the findings of MRA comparing with conventional angiography(CA) and cerebral blood flow(CBF) studies using 99m Tc-HMPAO SPECT or H2O15-PET with or without diamox enhancement, and focusing on changes following surgery for EDAS. Our assessment involved 23 children with MMD, in whom 44 EDAS procedures were performed. On MRA compared with CA, stenosis of internal carotid arteries was accurately visualized in eight of 19 hemispheres (42%) and augmented in 11(58%). The visualization of basal moyamoya vessels was accurate in ten hemispheres (53%), underestimated in seven(37%) and non-visualized in two(11%). Changes in the middle and anterior cerebral artery were similarly visible in both MRA and CA studies. Evaluation of postoperative MRA showed that at the site of surgery, the major change was dilation of the superficial temporal artery, seen in 89% of cases; the presence of anastomoses in this artery was confirmed in 13 of 19 hemispheres(68%). In comparison with perioperative CBF studies, basal CBF improved in 23 of 36 hemispheres(64%) within one year of surgery. In particular, early improvement of basal CBF, within 3 months, was observed in seven hemispheres(30.4%). CBF studies with diamox enhancement showed that after surgery, vascular reserve was normal or improved in eight of 12 hemispheres(67%). In conclusion, it may be stated that although definitive diagnosis requires further improvement in the delineation of fine vasculature, MRA promises to become a useful alternative to conventional angiography in the diagnosis and postoperative evaluation of MMD. To understand the effects of surgery on MMD, perioperative CBF studies are mandatory.
Key Words: Moyamoya disease; CBF study; MR angiography
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